For two years, Ferdinand Dix repeatedly filed requests with Arizona's Tucson state prison staff, asking to be examined for a chronic cough, shortness of breath and loss of appetite.

When Dix, who was serving five years on forgery and drug charges,
finally received a checkup, the doctor didn't notice cancer had caused
his liver to swell to four times its normal size. He told Dix to drink
energy shakes.

It wasn't until he was "nonresponsive" and had been transported to an
outside hospital that Dix was diagnosed with small-cell lung cancer. He
died a few days later, on Feb. 11. He was 47.

Dix's case is cited in a federal lawsuit accusing the Arizona
Department of Corrections of medical neglect. It's a charge the system
has faced before, from activists, inmates' families and at least one
Arizona lawmaker.

A review by The Arizona Republic of deaths in state prisons
over the past two fiscal years found at least four inmates, in addition
to Dix, whose medical care was delayed or potentially inadequate leading
up to their deaths. The records of these cases, together with
interviews of officers, medical staff and inmates point to a system in
which correctional officers routinely deny inmates access to timely
care, and in which treatment sometimes falls short of accepted
standards.

These deaths are among dozens of examples of preventable deaths uncovered in a broad investigation by The Republic into high rates of suicide, homicide and accidental deaths in state prisons.

Corrections Director Charles Ryan denies that health care in
Arizona's prisons is inadequate or that there is an institutional
indifference toward ailing inmates.

But Corrections officials do acknowledge that a long-planned
privatization of prison medical care has made it difficult to fill
vacancies. They also say care has been hobbled for more than a year by
cuts to outside contractor payments, which state lawmakers imposed two
years ago.

Allegations of substandard care, however, predate those developments.
For example, the suit in which Dix is named -- filed in March by the
American Civil Liberties Union and the Prison Law Office of San Quentin,
Calif., -- lists dozens of allegations of inmates waiting months for
medicine or medical treatment, and suffering permanent damage and
disfigurement as a result.

Ash warned that providing inadequate care not only harmed inmates, it
also exposed the state to costly lawsuits. His effort to fund improved
care for prisoners garnered little support in the Legislature.

"They're out of sight, out of mind. And they don't vote," he said of inmates.
There is also a general lack of public sympathy for prisoners, particularly those who have committed heinous crimes.

Take Carey Wheatley, a convicted child molester serving a life term.
He was 49 when he died of pneumonia on April 24, 2011, while in solitary
confinement at the Florence state prison. For days leading up to his
death, nurses offered him only the pain reliever acetaminophen,
according to the Pinal County medical examiner's report.

Medical experts say antibiotics or antivirals are the standard course of treatment for bronchial pneumonia.

When Daniel Porter, who shot to death two clerks at a Circle K store
in Tucson in 1986, was sentenced in 1992 to life on two murder charges,
he begged to be put to death. But the Superior Court judge ruled that
the murders were the result of mental illness -- paranoid schizophrenia
-- which caused Porter to believe the clerks were trying to poison him.
He also noted that Porter had been beaten and sexually abused as a child
by his father and stepfather, and had been in and out of mental
hospitals beginning when he was 13.

When Porter died, it was the result of hyponatremia, a chronic sodium
deficiency that causes excessive thirst. Porter drank gallon after
gallon of water for days, while correctional officers yelled at him to
stop drinking or occasionally hit him with pepper spray, according to a
report by Corrections investigators. He died in solitary confinement at
Eyman state prison on Feb. 20, having literally drunk himself to death
with water. Corrections officials listed his death as "accidental."

"His sodium deficiency was well documented," said Porter's sister,
Elaine Faith.
"That he was allowed to go two, three days drinking that
much water and they knew about it and didn't take him in because he
needed IV therapy."

Kenneth Lucas, 65, died Oct. 4 at the Eyman state prison of a heart
attack -- "natural causes," according to Corrections. But according to
the same lawsuit that cites Dix's death, when Lucas collapsed in his
housing unit the day before, other prisoners yelled to officers to
contact medical staff but officers didn't take action.

Another inmate, finding no pulse, performed CPR, and Lucas began breathing again.

Officers then took him to the medical unit, where an appointment was
set for a few days later. He died before he could be seen by medical
staff.

The inmate who had performed CPR on Lucas was disciplined for
breaking a rule that prohibits inmates from performing medical
procedures, according to the lawsuit.

A Corrections spokesman declined comment on the case, citing the litigation.
Donna Hamm, a former state judge and prisoner advocate, said
incarceration is the punishment for prisoners, not inadequate health
care. And Arizona has a constitutionally mandated obligation to provide
adequate care to prisoners, she said.

"The delays are just incredible," she says. "I've advocated for
people who've been diagnosed with a lump or growth and who are supposed
to be biopsied and have to wait six months, eight months, extraordinary
amounts of time before being diagnosed."

A class-action ACLU suit alleges that medical and mental-health care
in Arizona's prison system is so inadequate as to be unconstitutional
and demands improvements in access to and quality of care, and "timely
and competent" emergency response.

By the end of June, Wexford Health Sources Inc. of Pittsburgh will
assume responsibility for medical and mental-health care at Arizona's
state prisons under a three-year, $349 million contract. Wexford's
contract includes performance standards for inmate care, including
deadlines for inmates to be seen following a request for care and
guarantees that prescriptions will be filled within a specific time.

The Department has struggled in the past two years with a
medical-staff vacancy rate consistently higher than 20 percent, among
other problems. Corrections spending on medical care fell 27 percent
from fiscal 2009 to 2011, to $111.3 million, or an average of $3,258 an
inmate.

Critics, though, citing Wexford's mixed record elsewhere, are
skeptical about whether it will improve care. Regardless, Daniel
Pochoda, the ACLU's Arizona director, said the change in management
won't alter the legal demands for improvements in the suit.

Michelle Lependorf, the sister of Ferdinand Dix, said that she hopes the lawsuit leads to improved care.

"The real Ferdinand was loving, charming, fun to be around and
caring," she said. Because of poor medical care, "the person they turned
him into was angry, in pain, suffering and mistreated. ... He should
have had a chance to live. They gave him none."

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ACLU-Arizona Complaints

SUING Jan Brewer's Arizona: March 2012 Class Action Lawsuit filed against AZ DOC Director Charles Ryan and Health Services Division Director Richard Pratt due to unconstitutional standards of medical and psychiatric care, as evidenced by the doubling of suicide and homicide rates and a number of avoidable deaths in custody. The lawsuit also challenges the use of solitary confinement for managing the symptoms of mental illness as being particularly cruel and unusual.

JUST DETENTION: Stop Prison Rape

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Arizona Prison Watch

A community resource for monitoring, navigating, surviving, and dismantling the prison industrial complex in Arizona.

HELP FREE MARCIA POWELL!

AZ DOC: Prisoner Database

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AZ DOC NEWS / Prisoner Death Notices.

AZ DOC Constituent Services' Handbook

The rules they want prisoners' families to play by. Contact Peggy if they don't work (480-580-6807).